Provider Demographics
NPI:1164919627
Name:VYAS, SHRUTI (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:
Last Name:VYAS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3329
Mailing Address - Country:US
Mailing Address - Phone:757-220-3311
Mailing Address - Fax:757-525-2854
Practice Address - Street 1:2114 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2409
Practice Address - Country:US
Practice Address - Phone:757-224-7605
Practice Address - Fax:757-525-2854
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0103301332213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program